Simultaneous adjuvant radiation therapy and chemotherapy in high-risk breast cancer—toxicity and dose modification: A transtasman radiation oncology group multi-institution study

Denham, James W.; Hamilton, C.S.; Christie, David; O'Brien, Maree; Bonaventura, Antonino; Stewart, John; Ackland, Stephen P.; Lamb, David; Spry, Nigel; Dady, P J; Ch, Atkinson; Wynne, Christopher; Joseph, David

doi:10.1016/0360-3016(94)e0065-r

Cited by 27 publications

(6 citation statements)

References 18 publications

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“…Several have reported a deleterious effect of RT on the ability to deliver optimum doses of CT and have suggested that this may affect treatment outcome (13)(14)(15)). An increased level of toxicity may compromise the optimal dose delivery with respect to both RT and CT (16).…”

Section: Discussionmentioning

confidence: 99%

Concurrent Cyclophosphamide, Methotrexate, and 5-Fluorouracil Chemotherapy and Radiotherapy for Early Breast Carcinoma

Livi

Saieva

Borghesi

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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Section: Discussionmentioning

confidence: 99%

Concurrent Cyclophosphamide, Methotrexate, and 5-Fluorouracil Chemotherapy and Radiotherapy for Early Breast Carcinoma

Livi

Saieva

Borghesi

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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“…For this reason, we have reviewed our experience at the Princess Margaret Hospital, where our policy since the 1980s has been to administer RT concurrently with chemotherapy when CMF is selected as adjuvant systemic therapy. Another nonrandomized study of simultaneous adjuvant CMF and RT for early breast carcinoma has been reported by the Trans‐Tasman Radiation Oncology Group (TROG) 23, 24. Between 1981 and 1995, 268 patients from 4 cancer centers participated in the study.…”

Section: Discussionmentioning

confidence: 99%

“…component of the chemotherapy was administered. There appeared to be no increase in acute soft tissue reactions or impaired cosmetic outcomes 23. The first site of recurrence was recorded and for patients who had undergone BCS the 4‐year local and regional/distant recurrence rates were 6.3% and 27%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Concurrent cyclophosphamide, methotrexate, and 5‐fluorouracil chemotherapy and radiotherapy for breast carcinoma

Isaac

Panzarella

Lau

et al. 2002

Cancer

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BACKGROUND The current study was conducted to assess the toxicity of concurrent adjuvant cyclophosphamide, methotrexate, and 5‐fluorouracil (CMF) chemotherapy and radiotherapy (RT) for early breast carcinoma. METHODS In the current study, the authors reviewed the records of 680 consecutive breast carcinoma patients who received adjuvant CMF at the Princess Margaret Hospital between 1980–1990. Surgery was comprised of mastectomy in 64% of patients, breast conservation in 35% of patients, and was unknown in 1% of patients. Two hundred two patients received concurrent CMF/RT that was defined as an overlap in CMF and RT administration of at least 21 days. Forty‐seven patients received sequential CMF/RT (defined as no overlap or an overlap of < 7 days in CMF and RT administration). Other patients received CMF alone. Adverse effects of RT were graded retrospectively using the Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) system. Reasons for interruption or failure to complete RT were recorded. The magnitude of chemotherapy dose reductions and delays also were noted. RESULTS The median age of the patients was 44 years (range, 26–68 years) and 88% of the patients had lymph node‐positive disease. RT was interrupted or discontinued due to side effects in 4% of patients (95% confidence interval [95% CI], 1.7–7.7%) and 0% (95% CI, 0–7.6%), respectively, of the concurrent and sequential groups (P = 0.36). The incidence of Grade 3 or Grade 4 RT toxicity was 1.5% (95% CI, 0.3–4.3%) and 2.1% (95% CI, 0.1–11.3%), respectively, for the concurrent and sequential groups (P = 0.57). The median relative dose intensity of chemotherapy for patients receiving concurrent CMF/RT, sequential CMF/RT, and CMF alone was 0.87, 0.84, and 0.85, respectively (P = 0.22). CONCLUSIONS The results of the current study demonstrate that the concurrent administration of CMF and RT is associated with a low risk of serious toxicity and is an acceptable adjuvant regimen for patients with breast carcinoma. Cancer 2002;95:696–703. © 2002 American Cancer Society. DOI 10.1002/cncr.10744

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“…Subsequently, these centres reported that they were unable to detect increased acute soft-tissue reactions or impaired cosmetic outcomes in a series of 138 patients treated in this way. 20,21 They also found that the only adverse haemato-logical effects from this type of scheduling is lymphopenia, and that, as a result, chemotherapeutic dose reductions are not required more frequently during and after radiotherapy if absolute neutrophil count rather than total white cell count is used in the dose-reduction decision-making process. 21 In the last few years CMF regimens have been utilized less frequently in Australasia due to the widespread introduction of anthracycline-based regimens.…”

Section: Introductionmentioning

confidence: 99%

Simultaneous adjuvant radiotherapy and chemotherapy for stage I and II breast cancer

Lamb

Joseph

et al. 1999

Australasian Radiology

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The purpose of the present paper was to evaluate treatment outcome after conservative breast surgery or mastectomy followed by simultaneous adjuvant radiotherapy and cyclophosphamide, methotrexate and fluorouracil (CMF) therapy. Two hundred and sixty eight (268) patients were treated at two Australian and two New Zealand centres between 1981 and July 1995. One hundred and sixty-nine patients underwent conservation surgery and 99 had mastectomies. Median follow-up was 53 months. Conventionally fractionated radiation was delivered simultaneously during the first two cycles of CMF, avoiding radiation on the Fridays that the intravenous components of CMF were delivered. In conservatively treated patients, 5-year actuarial rates of any recurrence, distant recurrence and overall survival were 34.5 +/- 5.2%, 25.4 +/- 4.5% and 75.5 +/- 4.8%, respectively. Crude incidence of local relapse at 4 years was 6.3% and at regional/distant sites was 26.3%. Highest grades of granulocyte toxicity (< 0.5 x 10(9)/L), moist desquamation, radiation pneumonitis and persistent breast oedema were recorded in 10.7, 8.5, 8.9 and 17.2%, respectively. In patients treated by mastectomy, 5-year actuarial rates of any recurrence, distant recurrence and overall survival were 59.7 +/- 7.3%, 56.7 +/- 7.4% and 50.1 +/- 7%. The crude incidence of local relapse at 4 years was 5.6% and at regional/distant sites it was 45.7%. The issue of appropriate timing of adjuvant therapies has become particularly important with the increasing acknowledgement of the value of anthracycline-based regimens. For women in lower risk categories (e.g. 1-3 nodes positive or node negative), CMF may offer a potentially better therapy, particularly where breast-conserving surgical techniques have been used. In such cases CMF allows the simultaneous delivery of radiotherapy with the result of optimum local control, without compromise or regional or systemic relapse rates. Further randomized trials that directly address the optimal integration of the two modalities, such as the one carried out in Boston, are clearly necessary.

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Simultaneous adjuvant radiation therapy and chemotherapy in high-risk breast cancer—toxicity and dose modification: A transtasman radiation oncology group multi-institution study

Cited by 27 publications

References 18 publications

Concurrent Cyclophosphamide, Methotrexate, and 5-Fluorouracil Chemotherapy and Radiotherapy for Early Breast Carcinoma

Concurrent Cyclophosphamide, Methotrexate, and 5-Fluorouracil Chemotherapy and Radiotherapy for Early Breast Carcinoma

Concurrent cyclophosphamide, methotrexate, and 5‐fluorouracil chemotherapy and radiotherapy for breast carcinoma

Simultaneous adjuvant radiotherapy and chemotherapy for stage I and II breast cancer

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